About the Blog Author-John R. Hughes, MD
John R. Hughes, MD is Professor of Psychiatry, Psychology and Family Practice at the University of Vermont. Dr. Hughes is board certified in Psychiatry and Addiction Psychiatry. His major focus has been clinical research on tobacco use. Dr. Hughes received the Ove Ferno Award for research in nicotine dependence and the Alton Ochsner Award Relating Smoking and Health. He is a co-founder and past president of the Society for Research on Nicotine and Tobacco, and the Association for the Treatment of Tobacco Use and Dependence. Dr. Hughes has been Chair of the Vermont Tobacco Evaluation and Review Board which oversees VT’s multi-million dollar tobacco control programs. He has over 400 publications on nicotine and other drug dependencies and is one of the world’s most cited tobacco scientist. Dr. Hughes has been a consultant on tobacco policy to the World Health Organization, the U.S. Food and Drug Administration, and the White House. His current research is on how tobacco users and marijuana users stop or reduce use on their own, novel methods to prompt quit attempts by such users, whether smoking cessation reduces reward sensitivity and whether stopping e-cigarettes causes withdrawal. Dr Hughes has received fees from companies who develop smoking cessation devices, medications and services, from governmental and academic institutions, and from public and private organizations that promote tobacco control.
In prior blogs, I have reviewed the retrospective studies suggesting that smokers who quit spontaneously do not have worse outcomes and often have better outcomes than those who delay and plan their quit attempt. These findings challenge the common practice of asking smokers to delay quitting in order to engage in several preparatory activities (e.g. gather social support, self‐monitor when smoke during the day, or explore medication use). Recent work now challenges ....
In my prior entries, I have mentioned the need for studies showing that face‐to‐face counseling is worth the extra cost. Such individual treatment can never be as cost‐effective as less‐intensive treatment. In fact, in medicine there are very few cases where more intensive treatment is more cost‐effective.
Recently, two studies have tested more vs less intensive treatment. In one study, 300 smokers in dental care were randomized to low intensity treatment (one 30 min session) or high intensity treatment (eight 40 min sessions over 4 months‐i.e. 320 min)....
Vangeli et al (Addiction 106: 2110-2121, 2011) identified eight large, population based studies of smoking cessation in the real world. The surveys included both US and other countries. Six used data acquired between 2000 and 2010. These studies offer the most generalizable test of predictors of making a quit attempt or predicting success once one tries to quit.
This month’s blog focuses on options once a smoker has relapsed (is smoking regularly - usually defined as smoking for 7 consecutive days).
The advice for lapses in the last blog also applies for relapses; i.e., discuss the possibility of lapse/relapse at treatment initiation, explore what caused the relapse and problem solve, continue medication, and smoke as little as possible. There is a belief that it’s best for relapsers to wait and recover from the disappointment of failure before they try to stop again. There is no evidence...